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Eur J Pediatr Surg 2015; 25(01): 27-33
DOI: 10.1055/s-0034-1387942
Original Article
Georg Thieme Verlag KG Stuttgart · New York

International Survey on the Management of Necrotizing Enterocolitis

Authors

  • Augusto Zani

    1   Department of Pediatric Surgery, Sapienza University of Rome, Rome, Italy

  • Simon Eaton

    2   Department of Paediatric Surgery, University College London, Institute of Child Health, London, United Kingdom

  • Prem Puri

    3   Department of Pediatric Surgery, National Children's Research Centre, Dublin, Ireland

  • Risto Rintala

    4   Department of Paediatric Surgery, Hospital for Children and Adolescents, Helsinki, Finland

  • Marija Lukac

    5   Department of Pediatric Surgery, Faculty of Medicine, University Children's Hospital, Belgrade, Serbia

  • Pietro Bagolan

    6   Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy

  • Joachim F. Kuebler

    7   Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria

  • Michael E. Hoellwarth

    8   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany

  • Rene Wijnen

    9   Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen,The Netherlands

  • Juan Tovar

    10   Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

  • Agostino Pierro

    11   Department of Paediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
    • on behalf of the EUPSA Network
Further Information

Publication History

15 May 2014

23 June 2014

Publication Date:
26 October 2014 (online)

Also available at
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Abstract

Aim The aim of this study is to define patterns in the management of necrotizing enterocolitis (NEC).

Methods A total of 80 delegates (81% senior surgeons) from 29 (20 European) countries completed a survey at the European Pediatric Surgeons' Association 2013 annual meeting.

Results Overall, 59% surgeons work in centers where > 10 cases of NEC are treated per year. Diagnosis: 76% surgeons request both anteroposterior and lateral abdominal X-rays, which are performed at regular intervals by 66%; 50% surgeons also request Doppler ultrasonography; most frequently used biochemical markers are platelets (99% of surgeons), C-reactive protein (90%), and white cell count (83%). Laparoscopy is performed for diagnosis and/or treatment of NEC by only 8% surgeons. Overall, 43% surgeons reported being able to diagnose focal intestinal perforation preoperatively. Medical NEC: medical NEC is managed by surgical and neonatal teams together in most centers (84%). Most surgeons (67%) use a combination of two (51%) or three (48%) antibiotics for more than 7 days, and keep patients nil by mouth for 7 (41%) or 10 (49%) days. Surgical NEC: In extremely low-birth-weight infants (< 1,000 g) with intestinal perforation, 27% surgeons opt for primary peritoneal drainage (PPD) as definitive treatment. Overall, 67% think that peritoneal drainage is important for stabilization and transport. At laparotomy, treatments vary according to NEC severity. About 75% surgeons always close the abdomen, and 29% leave a patch to prevent compartment syndrome. Postoperative management: Infants are kept nil by mouth for 5 to 7 days by 46% surgeons, more than 7 days by 42%, and less than 5 days by 12% surgeons. Most surgeons (77%) restart infants on breast milk, 11.5% on aminoacid-based formulas, and 11.5% on hydrolyzed formulas. Most surgeons (92%) follow-up NEC patients after discharge, up to 5 years of life (56%) and 65% surgeons organize a neurodevelopmental follow-up.

Conclusions Many aspects of NEC management are lacking consensus and surgeons differ especially over surgical treatment of complex cases and postoperative management. Prospective multi-center studies are needed to guide an evidence-based management of NEC.

Keywords

NEC - premature infant - questionnaire